肿者，肌肉之肿，肿于面目四肢者也。胀者，腹中之胀，胀于胸腹之间者也。肿为轻而胀为
重。肿胀兼有，虽重犹可十全其五。此症有虚有实，若面目四肢，咸无肿形，但腹胀大如鼓，是名单
腹胀，亦曰鼓胀，属虚者多重而难治。经曰∶饮入于胃，游溢精气、上输于脾，脾气散精，上归于
肺，通调水道，下输膀胱。肿胀者，或因食积，或因滞，或因瘀血，或因湿热，或因燥热，阻滞中
宫，脾不散精，肺不通调，以致清浊不分，水道不利，遂成肿胀。然脾胃元气，犹未衰惫，苟能辨其食
积痰血，湿热燥热而治之，更当察其在气者，破其结气，则气道通行，而三焦不致壅闭，在水者，清
其肺金，则膀胱气化，而水湿不致淫溢，内邪一行，肿胀随消。即挟虚所致，如饮食频伤，或寒凉太
过，或病后产后，总以理脾为主，视所挟症加减。无不获效。故脾虚不能运化，气虚肿胀者，脾健自能
运气也，土虚不能制水，泛滥肿胀者，土旺自能制水也。观《金匮》治肿之大法，
谓诸有水者，腰以上肿，当发汗，腰以下肿，当利小便，开鬼门，洁净府。盖邪从汗散，水向便通
也。按喻沈二氏之论，欲发汗者，当兼实表，如人参败毒散之类。欲利小便者，当兼养阴，如四苓散
加地、冬之类，方为良手。大抵此症初起易治，以正未虚，而邪未甚也。久遂难痊，以邪已炽，而正
已衰也。贾洛阳谓病肿不治，必为锢疾，虽有扁卢，亦莫能为。肿之危害，犹尚如此，况鼓胀乎。鼓胀一
症，东垣主寒，河间主火，丹溪主脾虚，论似有异，然各发明《内经》，同出一原。经曰∶脏寒生满
病。又曰∶胃中寒主胀满。盖人身之气，热则流通，寒则凝结，凝结则胀满生焉。经曰∶诸胀腹大，皆
属于热。大凡物热盛则丰隆，寒盛则敛缩。故热气内盛则胀满，但有湿热燥热之分。经曰∶脾虚则腹胀肠
鸣，飧泄食不化。所谓气虚中满者是也。此则宜遵丹溪扶脾补气之治。故三子之说，不可偏废，并宜详究。
按虞天民论鼓胀，属寒者少，属热者多。又谓鼓胀起于脾虚气损，治之当以大补之剂，培其根本，少加顺
气，以通其滞，有挟积者，佐消导以祛其积，有挟热者，加寒凉以清其热。如单用大补，而佐使不明，则
反成壅滞，而胀愈甚矣。故此症脾虽损，而无热以扰之，则一补脾而获愈；热虽有而脾未损，则一清热而
奏功。如二者俱有，则将大补脾之正
气，而正气未受补，邪热先炽矣；将清热以伐邪，而邪未退，正气愈虚矣。故虚症医治最难，而虚症之
不可用温补，而宜用清补者之尤难也。兹而间遇实症，则因气郁者理气，因食积者消积，因瘀血者消瘀，
因痰滞者化痰，对症投剂，自无不效。但虚实之辨，不可不明。景岳谓肿胀，大都先胀于内，而后肿于外
者多实；失肿于表，而后胀于里者多虚。小便黄赤，大便秘结，多实；小便清白，大便溏泄，多虚。
脉滑数有力者多实，弦浮微细者多虚，面色红声粗者多实，色悴声短者多虚。诸凡实症，或六淫外客，
或气食内伤，阳邪急速，其来必暴，每成于数日之间；若是虚症，或情志积劳，或酒色过度，日积月累，
其来有渐，每成于经月之后。世人不察虚实，专守下则胀已之一法，虽得少宽于一时，真气愈衰，未几而
肿胀再作，遂致不救，故临症用补用泻，最当详审。总使实症治从清利，才见平复，即当培补根本为主。
夫肿胀之病，多有标实本虚者，泻之不可，补之无功，最为危候。以上诸法，此其大略也。肿胀重病，是
贵医者望闻问切之神明，对症施治，以尽其变通之妙。则善考《内经》论五脏六腑，各有肿胀。景岳谓，经
言∶诸湿肿满胀，皆属于脾。又言其本在肾，其末在肺，皆聚水也，又言肾者胃之关也，关门不利，故聚
水而从其类也，虽诸经皆有肿胀，而脾主营运，肺主气化，肾主五液，无不由于脾、肺、肾三
脏，此真知本之言夫。
大安丸〔即保知丸加白术。〕治食积肿胀，或单腹胀大，〔必中脘有微块，按之微痛。〕饮食
不快，〔伤食故恶食。〕小便不通，大便或溏或秘。
白术〔健脾，土炒。〕茯苓〔利水。〕楂肉 麦芽 神曲〔消积，各三两。〕卜
子〔除膨。〕橘红〔理气。〕连翘仁〔清热。〕半夏〔消痰，各二两，无湿痰者大忌。〕
咳喘加桑皮、苏子，积多加莪术， 热甚加黄连，渴去半夏，加麦冬，小便不利加车前，虚者
加人参。〔或丸或散，或汤俱可。〕
此方健脾、消积、清热，数剂知，半月一月愈矣。虞天民云∶大抵肿胀食积而成者为多，主此随
症加减，百发百中。余每合鸡金散用，甚效。
鸡金散
鸡内金〔消积，五钱，〕沉香〔四钱，〕砂仁〔六钱，〕陈香橼皮〔皆理气化滞
之品，焙一两，为末，白汤调服二、三钱。〕虚者参汤下。
此消积下气之剂，仿内经鸡矢醴方之法也。经曰∶有病心腹满，旦食则不能暮食，名为鼓胀，治
之以鸡，矢醴，〔干鸡矢，炒焦，酒煎服。最伤胃气，勿用。〕一剂知，二剂已。经又曰∶其时有复发
者，此饮食不节也。观此则知病愈后，当节饮食为要。
木香流气饮〔重订。〕治气郁腹胀，〔或因食、因痰、因恼
怒，气郁不行，则闭塞而致腹胀。〕皮浓色苍，或一身尽肿。或自上而下，〔皆气胀之的辨。〕按
之而不起。〔然水在肌肉之中，轻按则散亦不能猝聚，如按糟囊者然，不可不知。〕
木香 沉香 砂仁 苏子 橘红 枳壳〔皆利气之品，气利则郁自开，食自消，痰自降，水
自行。〕郁金〔开郁滞之气，又善能行瘀，恐气滞则血凝也。〕腹皮〔开心腹之气。〕甜
葶苈〔泄气分之闭。二味又均能逐水，恐气滞则水停也。〕如有热〔气郁则生火也。〕加连翘；〔
其性清凉，能除瘀热，其气芬芳，能散郁结。〕如因食滞，加山楂、麦芽；如因痰壅，加半夏、栝蒌。
此利气之剂也，果人壮气实，可用。嘉言谓若虚人腹胀，乃气散不收，更散其气，岂欲直裂其腹
乎？收之不能遽收。缓缓图成可也。即泻肺泻膀胱之药，亦不可施。按经言∶腹胀者，寒气客于皮肤
之间， 然不坚，腹大身尽肿，皮浓，按其腹 而不起，腹色不变。殆亦在气分之胀欤。
茯苓导水汤 治水气肿胀，眼胞上下微肿，肢体重着，〔湿伤肌肉故重。〕咳嗽怔忡，〔水气射
肺则咳，凌心故悸。〕股间清冷，皮薄色亮。或肿有分界，或自下而上，〔是水肿之的辨。〕或头面手
足遍身尽肿，手按随起，〔然气胀亦有按之随起者，如按气囊者然。〕小便秘涩，主此加减。
茯苓 泽泻〔洁净府。〕紫苏〔开鬼门。〕白术〔理脾或用米仁，或用茅术。〕麦
冬〔清肺。〕木香 砂仁 橘红〔利气。〕桑皮〔去肺中之水。〕腹皮〔逐皮肤之水。〕
木瓜〔和胃制肝，又能祛湿。〕槟榔〔破滞降气，又能下
水。〕甘澜水煎药。〔先将水煎数百滚，取其性达趋下，且水力轻微，不为肾之助也。〕如因食
滞，去木瓜，加枳实，山楂。如因痰壅，去木瓜、麦冬，加半夏、葶苈。如因湿热，去紫苏，加滑
石，海金砂。热甚，再加芩、连。
此导水之平剂。上症即《内经》水胀之病。经言∶水始起也，目窠上微肿，颈脉动，时咳，邻股
间寒，足胫肿，腹乃大，其水已成。以手按其腹，随手而起，如裹水之状。其论致病之因。则又言三
阴结谓之水，三阴者，手太阴肺，足太阴脾也。嘉言谓水病莫不本之胃经，乃以属之肺、脾者
何耶？使脾能转输水精于上，肺能通调水道于下，海不扬波矣。惟二脏之气结不行，则胃中之水日
蓄，浸灌表里，无所不到也。故治法宜伸脾，肺之权为主，然其要尤在于肾，肾为胃关，肾司开合故
也。虞天民言∶丹溪又有阳水之说，不过燥热为之，阴水之说，不过湿热为之也。至若《金匮》论
风水、皮水、正水、石水、黄汗五证，有志深造者，所宜审焉。
大戟枣子 治水肿如神。
大戟〔苦寒有毒，能下十二经之水，二钱。〕大枣〔恐下伤脾、胃，用以补之，百枚，
同煮一时，汁尽为度，去戟不用，取枣晒干，每日食枣数枚，分作三次服，以利为度，以平为期，服
此忌用甘草。〕
此逐水之峻剂也。药虽峻厉，得枣助之，且陆续以进，得利即止，果脉症俱实，宜下，若畏而
不服，反有养病害身
之患，较之舟车浚川、等方，虽为稍缓，然虚弱者。终不可轻用也。
麦冬饮 治燥热肿胀，〔肺燥则热，失清肃降下之令，不能通。调水道，渍于高原，淫于皮
肤，而水肿作矣。初病必或喘或咳。〕小便秘涩，〔虽秘，其少腹必不急。〕大便燥结。〔肺与大肠
为表里，燥热则不能濡润也。〕
麦冬〔清肺以开降下之源，两许。〕粳米〔益脾以培金之母，百粒。〕
此清金、润燥、培土之剂，古方虽未注治燥热肿胀，余谓此方甚是恰当，可参清燥救肺汤诸药用之。
调荣散〔重订。〕治瘀血肿胀，或单腹胀大，〔皮肉必现赤纹，或腹中有块，按之不移而
痛。〕不恶食，〔故知块为瘀血。〕小便赤，〔仲景云，小便自利，血症谛也。若兼热结膀胱气分，小
便亦不利矣。〕大便黑。〔瘀血渍之也。〕
丹参〔活血。〕桃仁〔各二、三钱。〕赤芍〔破血，钱许。〕刘寄奴〔破血下胀
之仙药，二、三钱。〕玄胡索〔活血化气之神品，钱许。〕泽兰〔行血化之水，二、三钱。〕
莪术〔破气中之血，钱许。〕热加连翘、黄芩，或再加童便。如欲行瘀，量加制大黄，或参用大
黄虫丸。〔不宜过剂。〕
此消瘀之剂也。瘀血化水，致成肿胀，其水不去，势必不瘀之血，亦尽化为水矣。故桑皮、腹皮、
葶苈之属，亦可采入。嘉言谓∶如挟虚者，须用人参大力者主持其间，则驱
逐之药，始能奏功，果虚而挟寒者，方可议加桂、附。又论蛊胀，与鼓胀不同。鼓胀者，中空无物，腹
皮绷急，多属于气。蛊胀者，中实有物，腹形充大，非虫即血。血蛊一症，东方沿海一带，擅鱼盐之饶，
比他处更多，男妇俱有。以鱼者，使人热中，盐者，走血，血得热合，久则中焦冲和之气，亦渐化为
热，气热则胀，血始不流。于是气居血中，血裹气外，渐至腹如抱瓮，观《内经》论石瘕，〔 血如
石。〕肠覃〔覃延布而深也。〕二症，言石瘕生于胞中，因恶血当泻不泻， 〔败血也。〕以留止，日
以益大，状如怀子，月事不以时下；若月事以时下，此肠覃之候，癖积因在肠外，不在胞中，故无妨月
事。盖由汁沫所聚而成，皆生于女子，可导而下。
金银花散 治疮毒内攻，肿胀或单腹胀大。
金银花〔除肿胀，解热毒，一、二、三两，为君。〕连翘仁〔疮家要药。〕黄芩、花
粉〔清热。〕橘红〔理气。〕茯苓、车前、木通〔导邪泄溺。〕腹皮〔散大肠壅毒，消水
气浮肿〕绿豆〔清热解毒，利水除胀。〕热毒内甚，加犀角黄连。
此清热解毒之剂，所谓治病必求其本也。
六味肾气汤 阴虚腰痛，腹大胫肿，〔经言肾病者，腹大胫肿，故两足必先肿也。〕咳喘有痰不
得卧，〔经言不得卧，卧则喘者，是水气之客也。肾者水脏，主津液，主卧与喘也。又水病其本在肾，其
末在肺，盖标本俱病也。〕甚至头面皆肿，〔阴虚火炎，水随火溢之故。〕饮食知味，〔胃无病也。〕溺
涩便燥，〔肾主二便，虚则不能濡润。〕此方主之。
六味地黄〔壮水补肾。〕麦冬 五味〔清金敛肺。〕牛膝〔利腰膝而消脚肿。〕车
前〔利小便而不走气。晓林云∶予曾用前方未效，加牛膝、车前即应。〕黑小豆〔黑色通肾，能
消水肿。〕煎汤煎药。
此壮水之剂。景岳云∶肿胀由于水邪，主水者，还求水脏，乃探本之治法也。世人患阴虚者甚多，
故相火泛滥其水而致肿胀者，赵氏此方，有功不浅。每见虚劳，而患此症者不少，若用破气利水燥热等
药，比于操刃。赵氏又云∶有一等肝经火郁肿胀，其症呕酸口苦，胁痛恶寒，面黄目黄，须以逍遥散舒
其郁，继以前方滋其阴，亦禁用分利。
济生肾气丸〔亦可小剂作煎。〕治脾肾虚寒，腹胀肢肿，小便不利，〔肾为胃关，关门不利，
则水聚于胃为 胀，水溢于四肢为浮肿，但溺虽少，而不黄赤，口不渴，手足冷，脉沉迟者，方作寒
治。〕或喘急痰盛。〔水乘肺则喘急，水泛上故痰盛。〕
八味地黄丸〔用桂、附补阳，蒸动肾气，使关门开，而胃中积水始下，以阳主开故也。〕牛膝
车前〔薛氏用茯苓为君，合此二味，治腰以下之水，其功甚大。〕
此蒸动肾气开关之剂，果属真阳衰弱，投之自然神效，按节斋言火衰成病者，百无一、二。薛氏赵
氏，极夸此方之神，以致盲师不辨寒热，一遇肿胀，概投此剂，为害不浅，用是方者，审之慎之。
加味异功散 治单腹虚胀。〔中空无物，腹皮绷急，多属于气。〕亦治脾虚肢体尽肿
人参 白术 茯苓 米仁〔补脾胃之元气，脾得补而胀自消。〕白芍〔胀病多属肝木乘
Swelling (Zhong) refers to edema of the muscles, manifesting as swelling in the face, eyes, and limbs. Distension (Zhang) refers to abdominal fullness, manifesting as a sensation of bloating between the chest and abdomen. Swelling is mild, whereas distension is severe. When both swelling and distension occur together, although the condition is serious, there is still a 50% chance of complete recovery. This syndrome can be either deficiency (Xu) or excess (Shi). If the face and limbs show no obvious swelling, but only the abdomen is distended like a drum, it is called "Single Abdominal Distension" (Dan Fu Zhang), also known as "Drum Distension" (Gu Zhang). It mostly belongs to deficiency patterns, is severe, and difficult to treat.
The *Classic of Internal Medicine* (*Huangdi Neijing*) states: "When fluids enter the stomach, they overflow with essence and qi, which are transported upward to the spleen. The spleen scatters the essence, sending it upward to the lung. The lung regulates the water passages, transporting them downward to the bladder." The causes of swelling and distension may include food stagnation, qi obstruction, blood stasis, damp-heat accumulation, or dry-heat flourishing. These factors obstruct the middle jiao (center palace), preventing the spleen from scattering essence and the lung from regulating water passages. Consequently, clear and turbid substances fail to separate, and water passages become obstructed, leading to swelling and distension. However, if the primordial qi of the spleen and stomach has not yet collapsed, treatment should differentiate whether the cause is food stagnation, phlegm-dampness, blood stasis, damp-heat, or dry-heat. Furthermore, one must observe whether the pathogen resides in the qi level or the water level. If in the qi level, resolve the constrained qi so that the qi pathways flow freely, preventing the blockage of the three jiao. If in the water level, clear the Lung Metal (Lung) to restore the qi transformation of the Bladder, preventing the overflow of water and dampness. Once internal pathogens are expelled, swelling and distension will subside. Even if caused by deficiency—such as frequent dietary injury, excessive consumption of cold foods, or post-illness/postpartum weakness—the primary treatment should focus on regulating the spleen, with modifications based on accompanying symptoms. Thus, for swelling caused by spleen deficiency failing to transform and qi deficiency, strengthening the spleen naturally promotes qi movement; for swelling caused by earth (spleen) deficiency failing to control water, strengthening the spleen naturally controls water.
Observing the general principles for treating edema in the *Jin Gui Yao Lue*, it states: "For patients with water disease, if swelling is above the waist, induce sweating; if below the waist, promote urination." This is referred to as "opening the ghost gate" (inducing sweat) and "cleaning the residence" (promoting urination). This is because pathogens disperse through sweat, and water exits through urine. According to Yu Jiayan and Shen Jin'ao, when inducing sweat, one should simultaneously consolidate the exterior, using formulas like Renshen Baidu San (Ginseng and Imperata Decoction). When promoting urination, one should simultaneously nourish yin, using formulas like Siling San (Four Poria Powder) added with Dihuang (Rehmannia) and Maidong (Ophiopogon). This is considered a skilled approach. Generally, this syndrome is easy to treat in its early stages because the healthy qi is not yet deficient and the pathogen is not severe. In chronic cases, it is difficult to cure because the pathogen is fierce and the healthy qi is depleted. Jia Luoyang stated that untreated edema becomes an entrenched disease; even with the skills of Bian Que or Lu Yi, it cannot be cured. The harm of edema is thus severe, let alone drum distension.
Regarding drum distension, Li Dongyuan emphasized cold, Liu Wanhuo emphasized fire, and Zhu Danxi emphasized spleen deficiency. Although their theories seem different, each elucidates the *Neijing* and shares a common origin. The *Neijing* says: "Cold in the zang organs generates fullness diseases." It also says: "Cold in the stomach governs distension and fullness." Generally, human qi flows freely when hot and coagulates when cold; coagulation leads to distension and fullness. The *Neijing* also states: "All distensions with abdominal enlargement belong to heat." Objects expand when heat is abundant and contract when cold is abundant. Therefore, internal flourishing of heat causes distension, distinguished into damp-heat and dry-heat. The *Neijing* says: "Spleen deficiency leads to abdominal distension, borborygmus, and undigested stool (sun xie)." This is what is meant by qi deficiency causing central fullness. Such cases should follow Zhu Danxi's method of supporting the spleen and tonifying qi. Therefore, the theories of Li, Liu, and Zhu should not be neglected but studied in detail.
Yu Tianmin argued that drum distension is rarely due to cold and often due to heat. He stated that drum distension arises from spleen deficiency and qi damage; treatment should use major tonifying agents to cultivate the root, adding minor qi-regulating herbs to unblock stagnation. If accompanied by accumulation, add digestants; if accompanied by heat, add cooling herbs. If only major tonics are used without proper adjuvants, it may cause further stagnation and worsen distension. Thus, if the spleen is damaged but not disturbed by heat, tonifying the spleen alone cures it; if heat exists but the spleen is intact, clearing heat alone achieves success. If both exist, major tonification may fail as the healthy qi cannot accept it while pathogenic heat flares; clearing heat may fail as the pathogen remains while healthy qi depletes further. Therefore, treating deficiency syndromes is most difficult, especially those requiring clearing and tonifying rather than warming and tonifying. For excess syndromes, regulate qi for qi constraint, digest food for food stagnation, resolve blood stasis for stasis, and transform phlegm for phlegm obstruction. Symptomatic treatment yields results. However, differentiation of deficiency and excess is crucial. Zhang Jingyue said: Swelling usually manifests as internal distension first, followed by external edema, indicating excess; or external edema first, followed by internal distension, indicating deficiency. Yellow urine and constipation indicate excess; clear urine and loose stools indicate deficiency. Slippery, rapid, and forceful pulses indicate excess; wiry, floating, faint, and fine pulses indicate deficiency. Red complexion and coarse voice indicate excess; sallow complexion and short voice indicate deficiency. Excess syndromes, whether from six exogenous pathogens or internal qi/food injury, arise rapidly due to yang pathogens, forming within days. Deficiency syndromes, from emotional labor or sexual excess, accumulate gradually over months. People who fail to distinguish deficiency and excess and rely solely on purgatives may gain temporary relief but deplete true qi, leading to recurrence and death. Therefore, tonification and purgation must be carefully considered. After treating excess with clearing and draining, once stabilized, focus on tonifying the root. Many swelling cases have superficial excess and root deficiency; purging is ineffective, and tonifying is useless, representing a critical state. These methods are merely outlines. Treating severe swelling requires the physician's acute observation, listening, inquiry, and palpation, applying treatments flexibly based on the *Neijing*'s discussion of swelling in the five zang and six fu organs. Zhang Jingyue noted: "All dampness, swelling, and fullness belong to the spleen." Its root is in the kidney, its branch in the lung, all involving water accumulation. The kidney is the gate of the stomach; if the gate is obstructed, water accumulates. Although all meridians can have swelling, spleen manages transport, lung manages qi transformation, and kidney manages five fluids; thus, all stem from the spleen, lung, and kidney. This is a profound understanding of the root.
Da An Wan (Great Peace Pill) [Baizhi Wan plus Baizhu]: Treats swelling from food stagnation or single abdominal distension [must have a slight mass at Zhongwan, tender to pressure]. Poor appetite [due to food injury], urinary retention, loose or constipated stools.
Herbs: Baizhu (Atractylodis Macrocephalae Rhizoma) [strengthens spleen, stir-fried with soil]; Fuling (Poria) [drains dampness]; Sharen Rou (Crataegi Fructus); Maiya (Hordei Fructus Germinatus); Shenqu (Massae Fermentatae Medicamentosa) [resolve stagnation, 3 liang each]; Boluobo Zi (Raphani Semen) [relieves bloating]; Juhong (Citri Reticulatae Pericarpium Rubrum) [regulates qi]; Lianqiao Ren (Forsythiae Fructus) [clears heat]; Banxia (Pinelliae Rhizoma) [transforms phlegm, 2 liang each; contraindicated if no damp-phlegm].
Modifications: Add Sangbaipi (Mori Cortex) and Suzi (Perillae Fructus) for cough/wheezing; add Ezhu (Curcumae Rhizoma) for more accumulation; add Huanglian (Coptidis Rhizoma) for severe heat; remove Banxia and add Maidong (Ophiopogonis Radix) for thirst; add Cheqianzi (Plantaginis Semen) for difficult urination; add Renshen (Ginseng Radix et Rhizoma) for deficiency. [Can be made into pills, powder, or decoction.]
This formula strengthens the spleen, resolves stagnation, and clears heat. Effects seen in a few doses; cured in half a month to a month. Yu Tianmin said: Most swellings result from food stagnation; modifying this formula works effectively. I often combine it with Jijin San with great effect.
Jijin San (Chicken Gizzard Membrane Powder):
Herbs: Jineijin (Galli Gigerii Endothelium Corneum) [resolves stagnation, 5 qian]; Chenxiang (Aquilariae Lignum Resinatum) [4 qian]; Sharen (Amomi Fructus) [6 qian]; Chen Xiangyuan Pi (Eriobotryae Folium or Citri Erythrocarpii Pericarpium) [all regulate qi and resolve stagnation, roasted and ground to 1 liang; take 2-3 qian mixed with warm water]. For deficiency, take with Renshen decoction.
This is a formula for resolving stagnation and descending qi, modeled after the *Neijing*'s Jishi Li (Chicken Dropping Wine) method. The *Neijing* says: "Disease with heart and abdominal fullness, unable to eat at night after eating in the morning, is named Drum Distension. Treat with Jishi Li [dry chicken droppings, roasted until charred, decocted in wine. Harms stomach qi, do not use]. One dose sees improvement, two doses cured. The *Neijing* adds: 'If it recurs at that time, it is due to irregular diet.' Thus, dietary restraint is key after recovery."
Muxiang Liuqi Yin (Costus Flowing Qi Decoction) [Revised]: Treats qi-constraint abdominal distension [due to food, phlegm, or anger, causing qi stagnation and blockage]. Thick skin, dark complexion, or whole-body swelling. Or swelling from top to bottom [definitive signs of qi distension]. Pitting edema [However, water in muscles disperses upon light pressure and does not aggregate suddenly, like pressing a wine bag; this must be known].
Herbs: Muxiang (Aucklandiae Radix); Chenxiang (Aquilariae Lignum Resinatum); Sharen (Amomi Fructus); Suzi (Perillae Fructus); Juhong (Citri Reticulatae Pericarpium Rubrum); Zhike (Aurantii Fructus Immaturus) [all promote qi flow; when qi flows, constraint opens, food digests, phlegm descends, water moves]. Yujin (Curcumae Radix) [opens constrained qi, promotes blood circulation, fearing qi stagnation leads to blood coagulation]. Fupi (Tangerine Peel/Aurantii Fructus Pericarpium) [opens heart and abdominal qi]. Tinglyizi (Thladianthae Fructus) [vents closure in the qi level. Both drain water, fearing qi stagnation leads to water retention]. If heat [qi constraint generates fire] add Lianqiao (Forsythiae Fructus) [cooling, removes blood-heat, aromatic, disperses constraint]. If food stagnation, add Shanzha (Crataegi Fructus) and Maiya (Hordei Fructus Germinatus); if phlegm obstruction, add Banxia (Pinelliae Rhizoma) and Gualou (Trichosanthis Fructus).
This is a qi-promoting formula, suitable only for robust individuals with strong qi. Jiayan warned: If a deficient person has abdominal distension due to scattered qi, scattering more qi might rupture the abdomen. Recovery must be gradual. Even drugs that drain lung and bladder qi should not be used. The *Neijing* says: "Abdominal distension occurs when cold qi lodges in the skin; the abdomen is large, body swollen, skin thick, pitting upon pressure, color unchanged." This likely refers to qi-level distension.
Fuling Daoshui Tang (Poria Water-Guiding Decoction): Treats water-qiswelling, slight swelling of eyelids, heavy limbs [dampness injures muscles causing heaviness]. Cough and palpitations [water qi attacks lung causing cough, harasses heart causing palpitations]. Cold sensation in thighs, thin shiny skin. Or defined swelling, or ascending from below [definitive signs of water edema]. Or whole-body swelling including head, face, hands, feet, pitting immediately upon pressure [Note: Qi distension can also pit, like an air bag]. Scanty, difficult urination. Main formula with modifications.
Herbs: Fuling (Poria); Zexie (Alismatis Rhizoma) [cleanse the residence]. Zisu (Perillae Folium) [open the ghost gate]. Baizhu (Atractylodis Macrocephalae Rhizoma) [regulate spleen, use Coix Seed or Atractylodis Rhizoma]. Maidong (Ophiopogonis Radix) [clear lung]. Muxiang (Aucklandiae Radix); Sharen (Amomi Fructus); Juhong (Citri Reticulatae Pericarpium Rubrum) [promote qi]. Sangbaipi (Mori Cortex) [remove water from lung]. Fupi (Tangerine Peel) [drive water from skin]. Mugua (Chaenomelis Fructus) [harmonize stomach, control liver, dispel dampness]. Binglang (Arecae Semen) [break stagnation, descend qi, drive down water]. Decoct in Ganlan Shui (Galea Aqua) [boil water vigorously hundreds of times to lower its nature and reduce hydraulic force, avoiding aiding the kidney]. If food stagnation, remove Mugua, add Zhishi (Aurantii Fructus Immaturus) and Shanzha (Crataegi Fructus). If phlegm obstruction, remove Mugua and Maidong, add Banxia (Pinelliae Rhizoma) and Tinglyizi (Thladianthae Fructus). If damp-heat, remove Zisu, add Huashi (Talcum) and Haijinsha (Lygodii Spora). Severe heat, add Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma).
This is a mild water-guiding agent. The above symptoms correspond to "Water Distension" in the *Neijing*. The *Neijing* says: "At the start of water disease, slight swelling above the eyes, pulsation of the neck vessels, occasional cough, cold in the thighs, swelling of calves, then abdominal enlargement. Pressing the abdomen leaves an indentation that rises quickly, like wrapping water." Regarding etiology, it states: "Constriction of the three yin is called water. Three yin refers to Hand Taiyin Lung and Foot Taiyin Spleen." Jiayan asked: If water disease originates in the Stomach meridian, why attribute it to Lung and Spleen? If the spleen transports water essence upward and the lung regulates water passages downward, the sea would be calm. Only when these two organs' qi is constrained does stomach water accumulate, flooding interior and exterior. Thus, treatment should prioritize restoring spleen and lung authority, but the key lies in the kidney, as the kidney is the stomach gate controlling opening and closing. Yu Tianmin said: Danxi's Yang Water is due to dry-heat; Yin Water is due to damp-heat. For Wind Water, Skin Water, Correct Water, Stone Water, and Yellow Sweat discussed in *Jin Gui*, advanced students should examine them carefully.
Daji Zaizi (Kerria Date Fruit): Miraculous for edema.
Herbs: Daji (Euphorbiae Pekinensis Radix) [bitter, cold, toxic, drains water from twelve meridians, 2 qian]; Dazao (Jujubae Fructus) [fearing downward action damages spleen/stomach, used to tonify, 100 pieces. Boil together for one hour until juice is absorbed. Remove Daji, dry dates. Eat several dates daily, divided into three doses. Stop when bowel movements occur. Maintain balance. Avoid Gancao during use.]
This is a harsh water-draining agent. Though harsh, aided by dates and administered gradually, stop upon evacuation. Suitable only for excess patterns with solid pulse/symptoms. Fear of taking it may nurture disease and harm life. Compared to Zhouche Jun Chuan San, it is milder, but still unsuitable for the weak.
Maidong Yin (Ophiopogon Drink): Treats dry-heat swelling [Lung dryness causes heat, losing descending function, failing to regulate water passages, flooding highlands and skin, causing edema. Early stage必有 wheezing or cough]. Scanty, difficult urination [though constipated, lower abdomen is not tense]. Dry, hard stools [Lung and Large Intestine are exterior-interior; dry-heat fails to moisten].
Herbs: Maidong (Ophiopogonis Radix) [clears lung to open descending source, 2 xu]; Jingmi (Oryza Sativa Germen) [benefits spleen to support metal's mother, 100 grains].
This clears metal, moistens dryness, and supports earth. Although ancient texts don't explicitly list it for dry-heat swelling, I find it appropriate. Refer to Qingzao Jiufei Tang for usage.
Tiaorong San (Regulating Blood Powder) [Revised]: Treats blood-stasis swelling or single abdominal distension [skin shows red streaks, or abdominal mass fixed and painful]. No aversion to food [thus mass is blood stasis]. Red urine [Jingyue: Free urination confirms blood disease. If combined with heat binding bladder qi, urination may be difficult]. Black stools [stained by blood stasis].
Herbs: Danshen (Salviae Miltiorrhizae Radix et Rhizoma) [invigorates blood]; Taoren (Persicae Semen) [2-3 qian each]; Chishao (Paeoniae Radix Rubra) [breaks blood, ~1 qian); Liu Jimu (Polygalae Tenuifoliae Radix) [immortal herb for breaking blood and reducing distension, 2-3 qian); Yanhusuo (Corydalis Rhizoma) [divine product for invigorating blood and transforming qi, ~1 qian); Zelán (Leonuri Herba) [moves blood and transforms water, 2-3 qian); Ezhu (Curcumae Rhizoma) [breaks blood within qi, ~1 qian). Add Lianqiao (Forsythiae Fructus) and Huangqin (Scutellariae Radix) for heat, or add Tongbian (Child's Urine). To move stasis, add Zhi Dahuang (Prepared Rheum Radix et Rhizoma) or Day Huang Chong Wan (Major Yellow and Ground Beetle Pill) [do not overdose].
This is a stasis-resolving agent. Blood stasis transforms into water, causing swelling; if water is not removed, non-stagnant blood will also turn to water. Thus, Sangbaipi, Fupi, and Tinglyizi can be added. Jiayan said: If accompanied by deficiency, use strong Renshen to support the driving herbs to work. If deficiency with cold, consider adding Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata). Also, Gu Distension differs from Drum Distension. Drum Distension is hollow, skin tight, mostly qi-related. Gu Distension is solid, abdomen enlarged, due to worms or blood. Blood Gu is common in coastal eastern regions due to fish and salt. Fish causes internal heat; salt moves blood. Heat and blood combine, turning middle jiao harmony into heat, causing distension and blood stagnation. Qi enters blood, blood wraps qi, abdomen enlarges like a jar. Refer to *Neijing*'s Shi Xia (Blood like stone) and Chang Qin (Spreading deep) discussing uterine fibroids and intestinal masses. Shi Xia arises in the uterus from retained evil blood, growing like pregnancy, disrupting menstruation. Chang Qin arises outside the uterus from fluid accumulation, not affecting menstruation. Both occur in women and can be guided out.
Jinyinhua San (Honeysuckle Powder): Treats swelling or single abdominal distension from internal attack of sore toxins.
Herbs: Jinyinhua (Lonicerae Japonicae Flos) [removes swelling, resolves heat-toxin, 1-2-3 liang, sovereign]; Lianqiao Ren (Forsythiae Fructus) [essential for sores]; Huangqin (Scutellariae Radix) and Fen Hua (Trichosanthis Radix) [clear heat]; Juhong (Citri Reticulatae Pericarpium Rubrum) [regulate qi]; Fuling (Poria), Cheqianzi (Plantaginis Semen), Mutong (Akebiae Caulis) [guide pathogen, drain urine via bladder]; Fupi (Tangerine Peel) [disperse large intestine congestion toxin, reduce water swelling]; Lv Dou (Phaseoli Semen) [clear heat-toxin, drain water, reduce distension]. Severe internal heat-toxin, add Xijiao (Rhinocerotis Cornu - substitute with Shuiniujiao) and Huanglian (Coptidis Rhizoma).
This is a heat-clearing and toxin-resolving agent, seeking the root of disease.
Liushen Qiji Tang (Six-Ingredient Kidney Qi Decoction): Yin-deficiency lumbar pain, abdominal enlargement, leg swelling [Neijing: Kidney disease causes abdominal enlargement and leg swelling, hence feet swell first]. Cough/wheezing with phlegm, inability to lie flat [Neijing: Inability to lie flat indicates water qi invasion. Kidney is water organ, governs fluids, bed, and wheezing. Water disease root in kidney, branch in lung, both affected]. Even head/face swelling [Yin deficiency, fire flares, water follows fire overflow]. Appetite normal [Stomach healthy]. Scanty urine, dry stools [Kidney governs two passages, deficiency fails to moisten]. This formula treats it.
Herbs: Liushen Dihuang Wan (Six-Ingredient Rehmannia Pill) [strengthen water, tonify kidney]; Maidong (Ophiopogonis Radix); Wuweizi (Schisandrae Fructus) [clear metal, astringe lung]; Niuxi (Achyranthis Bidentatae Radix) [benefit waist/knees, reduce foot swelling]; Cheqianzi (Plantaginis Semen) [promote urination without depleting qi. Xiaolin: Previous formula failed, adding Niuxi and Cheqian worked]; Hei Xiaodou (Sojae Semen Nigrum) [black enters kidney, reduces edema]. Decoct in water.
This strengthens water. Jingyue said: Swelling due to water pathogen, governing water seeks the water organ, a root-seeking method. Many suffer yin deficiency, causing ministerial fire to flood water and swell; Zhao's formula is highly effective. Often seen in consumptive diseases. Using qi-breaking, diuretic, or drying-hot drugs is like wielding a blade. Zhao also said: Liver-meridian fire-constraint swelling presents with sour regurgitation, bitter taste, hypochondriac pain, aversion to cold, sallow/jaundiced face. Use Xiaoyao San to soothe constraint, then this formula to nourish yin. Avoid diuretics.
Jisheng Shenqi Wan (Jisheng Kidney Qi Pill) [Can be small dose decoction]: Treats spleen-kidney deficiency-cold, abdominal distension, limb swelling, difficult urination [Kidney is stomach gate; gate obstruction causes water accumulation in stomach (distension) and overflow to limbs (edema). If urine is scant but not yellow/red, no thirst, cold extremities, deep-slow pulse, treat as cold]. Or wheezing/abundant phlegm [Water attacks lung causing wheezing; water floods upper causing phlegm].
Herbs: Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) [Gui/Zhi tonify yang, vaporize kidney qi, open gate, allowing stomach water to descend, as yang governs opening]; Niuxi (Achyranthis Bidentatae Radix); Cheqianzi (Plantaginis Semen) [Xue used Fuling as sovereign with these two to treat lower body water, very effective].
This vaporizes kidney qi to open the gate. Effective for true yang depletion. Jiezai said: Disease from fire failure is rare (1-2%). Xue and Zhao praised this formula greatly, leading to blind physicians ignoring cold/heat differentiation and indiscriminately using it for swelling, causing harm. Users must be cautious.
Jiawei Yigong San (Modified Miracle Work Powder): Treats single abdominal deficiency distension [Hollow, skin tight, mostly qi]. Also treats whole-body swelling from spleen deficiency.
Herbs: Renshen (Ginseng Radix et Rhizoma); Baizhu (Atractylodis Macrocephalae Rhizoma); Fuling (Poria); Yiyiren (Coicis Semen) [tonify spleen/stomach primordial qi; spleen strengthened, distension subsides]; Baishao (Paeoniae Radix Alba) [Distension often involves liver wood overacting spleen earth...